“Massive and durable” deprograms of surgical operations “loss of opportunity for non-Covid patients”.
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A “chronic crisis”: it is by this oxymoro that Ruddy Valentino, a resuscitator physician at the Martinique University Hospital (CHU), summarizes the situation prevailing in his critical care unit, the only one in this Caribbean department .
Since mid-December 2021, the island is prey to a fifth wave of the Cvid-19 epidemic, which started to overcome while the main hospital of the island, submerged by the previous wave A few months before, was far from having regained normal operation. “Six months after the July-August catastrophe, we are still in an extremely tense situation,” the practitioner moves. “Since September, we are on a high plateau of a dozen Covid patients admitted into an average resuscitation every week,” he adds.
This influx of patients remains considerable for a service that, before the pandemic, had only 26 resuscitation beds. The current capacity of the critical care unit has therefore been increased to 53 beds, of which 38 devoted to patients with CVIV-19. And not to arrange anything, the social conflict born of the rejection by the unions of hospital agents of the vaccination obligation is still far from being settled. “The staff is either tired or sick, either resigned”, deplore Dr. Valentino.
At this execrable context adds the “ethical dilemma” to which the teams of the critical care unit have been facing since the beginning of the fourth wave: that of the sorting of patients. From the admission of the resusciter doctor, “waiting lists continue to swell” in his service. “For six months, Covid courses are prioritized,” regrets the practitioner, with “massive and durable” deprographs of surgical operations “a loss of opportunity for non-Covid patients,” adds Dr. Valentino, who directs the Regional ethical reflection space of Martinique.
Equity principle
Faced with the saturation of the resuscitation service, this reflection cell attempts to provide guidance to caregivers in order to help them answer questions about sorting criteria that evolve according to the acuteness of the crisis to a precise moment. A needed help, because “working in such conditions, it causes a real suffering in caregivers”, worries Dr. Valentino.
Multidisciplinary team made up of doctors, but also users of the health system in Martinique, the ethical space of reflection has been for the mission of better enforcing a principle of equity in access to resuscitation and to “give meaning” to the action of caregivers, according to the practitioner. In a report dated January 10, 2022, in conjunction with the CHU Ethics Committee of Martinique, the cell leads to twelve recommendations for better care of patients, including the “rejection of the first-come principle, first served” , the holding of a sorting register or the refusal of the “prioritization according to the vaccine status”.
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